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Topic: CAN WE BILL MEDICAID WHEN IS IS SECONDARY (Read 4653 times)

We Have primary as Medicare and secondary ins as Medicaid, Medicare paid and secondary open amount is Less then 20% of Medicare allowed amount, do we get payment from Medicaid or do we have to write off the balance?

To my understanding Medicaid is a payor of last resort so if Medicare as primary paid more than what Medicaid would pay they do not pay anything. I am Florida so I don't know it works different if you are in a different state. We usually write of the balance if a patient has Medicaid. The only thing Medicaid pays for is the deductible. I called Medicaid on this many times and was told that because of the balance budget act we can not bill the patient.

However, there are some Medicaid plans that only pay for the patient's Medicare Premium and in that case we can bill the patient.

Medicaid should make payment. Any balance after Medicaid makes payment would be written off.

I've had many claims were Medicaid paid after Medicare, most notably my mental health patients in nursing homes. Granted the Medicaid Payments were pretty measley but they still paid secondary to Medicare.

Pay_My_Claims

Yes, that statement is fine, its the one that I copied that's questionable. Even the post subject says "can we bill medicaid when it is secondary" and since they are doing adjustments after medicaid pays, it says to me that after the primary pays they were w/o the balances "except for the deductibles" and letting it go. Now once medicaid paid (probably from a crossover) they would have to go back in and do adjustments. Why would you do adjustments if you haven't w/o anything??

Right I see what you are saying, what we should have said was.. don't write off or adjust anything off after primary pmt and adjustment UNTIL secondary payor pays. If they continue that practice they will just have to go and make adjustments to adjust down any secondary pmts/adjustments anyway. Messy file.